Wherever euthanasia is legal, the consciences of doctors and nurses must be protected

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A number of leaders from Christianity, Islam and Judaism recently joined forces in issuing a declaration at the Vatican opposing assisted suicide and euthanasia. The document expressly states that no health care provider should be "coerced or pressured" into providing assisted suicide or any form of euthanasia. As always when end of life issues are being discussed, this move raises a number of highly complex ethical and legal questions.

We live in an era of soundbites, with pressure to sum up a perspective in a few, pithy words, but this kind of topic really cannot be explored without digging into the deeper questions.

There can be no doubt that euthanasia is a matter about which sincere and compassionate people can and do disagree about, whether or not they have a faith. There is certainly a spectrum of opinion within the Abrahamic religions issuing this declaration, various traditions take differing approaches, and individuals also vary in their personal response. Even amongst people who might support or oppose euthanasia when asked to give a straight yes/no answer, there is a huge variety about what is actually meant by this.

Some people might be willing to approve assisted suicide, where the patient is given means to end their own life when ready, but believe that "voluntary active euthanasia" is a bridge too far, as this requires a clinician to actively participate in bringing about death.

Still others argue that any distinction between assisted suicide and euthanasia becomes unsustainable in the real world, often for one of two reasons. One common feeling is that it would be unjust and irrational to deny help to a patient who found themselves paralysed from the neck down after an accident the opportunity to end their life, purely on the basis of their physical limitations, when other citizens with incurable medical conditions were permitted to make a choice. It would, effectively, be discrimination on the basis of disability, where the most fundamental interests imaginable were at stake.

Another point which is often made, and famously articulated by the legal scholar John Keown, is that unless doctors were to assist anyone to die if they come forward asking to end their life, without any assessment about their mental capacity or circumstances, there will always be some active involvement in the process by third parties. This point is difficult to deny, as it is impossible to construct any legal regime which would adequately protect the vulnerable, without ensuring that there was a robust filtering of requests for euthanasia.

However, it is important to appreciate that the most significant part of this declaration is not about the legal status of euthanasia per se. There is a clear recognition that whilst faith groups, and indeed others, who are opposed to the practice may continue to campaign against legal reforms to permit or facilitate it, they ultimately have no control over secular Parliaments choosing to approve such measures.

What they are concerned to protect is the right to freedom of conscience for individuals working in healthcare. In short, they want to see guarantees that no doctors, nurses or others will face pressure or disadvantage if they choose not to participate.

This call is undoubtedly an entirely reasonable one, and is in line with the overarching values of liberal democracy. Freedom of conscience and belief is a core liberty which has long been recognised by Western culture, for example it is enshrined in Article 9 of the European Convention on Human Rights. Whether or not a legal system opts to introduce or liberalise regulation of euthanasia, the rights of doctors, nurses and others who do not wish to be involved in the active ending of human life to decline to participate must be preserved.

Measures like this can be introduced without the issue being presented in oppositional terms, or any suggestion that one group of people is any more compassionate or responsible than another. It is simply a matter of respecting the spiritual and ethical choices of every person at work.

There may of course be difficult grey areas, as there are in relation to the termination of pregnancy; how direct must the involvement in the process be for a person to decline to perform a particular function at work? But these issues can and must be worked through. A commitment to protecting individual rights to freedom of religion and conscience is an integral part of our shared political and legal framework.

Rev Dr Helen Hall is a Senior Lecturer at Nottingham Law School.